Women who had 5 or more cesarean-section deliveries had more bleeding, preterm births

For the study, British researchers compared 94 women who had five or more cesarean-section deliveries (called multiple repeat cesarean sections) with 175 women who had fewer C-sections. Women in the multiple C-section group were much more likely to have major obstetric hemorrhage (bleeding before, during or after delivery where blood loss exceeds 1,500 milliliters), blood transfusions, preterm delivery, and admission to critical care units.

Major obstetric hemorrhage occurred in 18 percent of the women in the multiple C-section group and 0.6 percent of the other women, and blood transfusions were required by 17 percent of the women in the multiple C-section group and 1 percent of the other women, the investigators found.

Women in the multiple C-section group were also more likely to have a preterm delivery (24 percent versus 5 percent), according to the study, published online and in the Oct. 31 print issue of BJOG: An International Journal of Obstetrics and Gynaecology.

Eighteen percent of the women in the multiple C-section group were diagnosed with placenta previa and/or placenta accreta, conditions where the placenta is abnormally positioned in the womb during pregnancy. These women had an even higher risk of complications than other women who had multiple C-sections, and half of them required a hysterectomy and two-thirds required critical care after delivery.

"Multiple repeat cesarean sections are an unusual occurrence and for most women the outcomes are very good. However, there is a higher risk of maternal complications and preterm delivery compared to women having fewer cesareans," study co-author Dr. Mandish Dhanjal, of the obstetrics and gynecology department at Imperial College Healthcare NHS Trust, said in a journal news release.

"We also found that these risks were greatest in women undergoing [multiple repeat cesarean sections] who also had placenta previa and placenta accreta. Obstetricians should be aware of this high-risk group of women and work in multidisciplinary teams in order to optimize their management," Dhanjal added.

John Thorp, journal deputy editor-in-chief, pointed out that more research is needed on these high-risk deliveries.

"It is important that both women and obstetricians are aware of the complications associated with repeat cesarean sections. All cesarean-section procedures carry risks, some that are life-threatening. Larger studies are needed to look at this in more detail before firm recommendations are made about the maximum number of cesarean sections which should be performed," Thorp said in the news release.